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Poster 86: Disorders of Consciousness due to Anoxic Brain Injury: A Case Series of 8 Patients
S164
Abstracts / PM R 9 (2017) S131-S290
Participants: Two normal controls. Interventions: No applicable. Main Outcome Measures: Creation of video and picture of the alternative view. Results: In a forearm held in the resting UMN injury pattern, the FDP is close to the top of the image just volar to the ulna, the FDS is deep to the FCU, and FDS and FCU are both lateral to FDP. Conclusions: A new teaching resource was developed to demonstrate the relative forearm muscle position in a more clinically relevant context for teaching US-guided forearm muscle injections. Level of Evidence: Level V Poster 83: Is It Possible to Diagnose Borderline Mild Carpal Tunnel Syndrome in Nerve Conduction Studies with Normal Median Motor and Sensory Latencies Without Using the Combined Sensory Index? Marc A. Raj, DO (LSU Health Med Cntr), Stephen Kishner, MD, Elena Khoutorova, Medical Student 4, Casey A. Murphy, MD Disclosures: Marc Raj: I Have No Relevant Financial Relationships To Disclose Objective: To determine criteria which can accurately predict or rule out borderline carpal tunnel syndrome in symptomatic patients with normal Median nerve sensory and motor latencies without the need to perform combined sensory indices using only Median to Ulnar motor and sensory latency differences. Design: Retrospective chart review. Setting: Outpatient PM&R clinic. Participants: 499 nerve conduction studies in 300 patients over a period of 9 years. Interventions: Not Applicable. Main Outcome Measures: Both Median to Ulnar nerve sensory and Median to Ulnar motor latency differences were calculated. Sensory, motor, and combined sensory/motor latency differences were correlated to the results of combined sensory index for their respective study using regression analysis. The regression analysis was then used to determine which latency differences would provide accurate predictions of the combined sensory index. Results: A combined Median to Ulnar nerve motor and sensory latency difference greater than 1.4ms (n¼113) had a specificity of 94% with a positive predictive value of 87% in predicting positive combined sensory indices. A combined Median to Ulnar nerve motor and sensory latency difference less than 0.5ms (n¼107) had a sensitivity of 90% with a negative predictive value of 75% in predicting negative combined sensory indices. These criteria were present in n¼220 (approximately 44% of studies). Conclusions: A combined Median to Ulnar nerve motor and sensory latency difference greater than 1.4ms can accurately predict borderline mild carpal tunnel syndrome without the need for combined sensory indices. Caution should be used in ruling out borderline mild carpal tunnel syndrome based on a combined Median to Ulnar nerve motor and sensory latency difference of less than 0.5ms as there is a relatively high false positive value of 25%. Level of Evidence: Level II Poster 86: Disorders of Consciousness due to Anoxic Brain Injury: A Case Series of 8 Patients Mark A. Linsenmeyer, MD (University of Pittsburgh Medical Center), Shanti M. Pinto, MD, Gary N. Galang, MD Disclosures: Mark Linsenmeyer: I Have No Relevant Financial Relationships To Disclose Objective: To characterize common medical complications, treatments, and recovery in patients with disorders of consciousness (DOC) due to anoxic brain injury (ABI).
Design: Retrospective case series. Setting: Academic inpatient rehabilitation (IPR) center. Participants: Eight patients with current or recent DOC due to ABI without history of head trauma who were admitted to IPR from 20152016. Interventions: Not applicable. Main Outcome Measures: Primary outcome measures included change in function (as measured by FIM score) and level of consciousness (as measured by JFK/CRS-R score). Secondary outcome measures included medical comorbidities (paroxysmal sympathetic hyperactivity [PSH], spasticity, movement disorders, seizures, or infections) and discharge destination. Results: On admission to IPR, 5 patients were vegetative and 3 had recently emerged from minimally conscious state (MCS). During IPR course, 2 vegetative patients emerged, 1 became minimally conscious, and 2 remained vegetative. FIM scores on admission were 18 or below for all patients and improved in 4 patients by an average of 40 points. Scores did not improve for the remaining 4. All patients were given neuropharmacologic medications for arousal and attention. PSH affected 6/8 patients and clinically resolved for 2 patients prior to discharge. 6/8 patients had spasticity, resolving in 3 by discharge. 5/8 patients exhibited movement disorders, primarily myoclonus. 7/8 patient developed urinary tract infections. No patients developed seizures during IPR admission, but 2/8 patients experienced status epilepticus prior to IPR. Overall, 6/8 patients were discharged to home. Conclusions: In IPR, patients with DOC due to ABI presented with prominent neurological and cognitive deficits, for which they were prescribed neuropharmacologic agents in conjunction with therapies. Common limitations to rehabilitation include the severity of deficits in arousal and cognition, PSH, spasticity, movement disorders, and a high rate of infection; however, many patients were frequently discharged to the home setting. Further investigation into predictors of outcome and optimal medical management for this population is warranted. Level of Evidence: Level IV
Poster 87: Effect of Neurodynamic Mobilizations on Fluid Dispersion on Median Nerve at the Level of the Carpal Tunnel: A Cadaveric Study Mathieu Boudier-Reveret (Universite´ du Que´bec a` Trois-Rivie`res, Trois-Rivie`res, Que´bec, Canada), Ste´phane Sobzack, PT, MSc, PhD, Kerry K. Gilbert, PT, ScD, Jean-Michel Brismee, PT, ScD, Pierre-Michel PM. Dugailly, PhD, Ve´ronique Freipel, PhD, Mehdi Moussadyk, Msc, Dorra Rakia DR. Allegue, pht, MSc Disclosures: Mathieu Boudier-Reveret: I Have No Relevant Financial Relationships To Disclose Objective: To evaluate the effect of neurodynamic mobilizations on an artificially induced intraneural edema in the median nerve at the level of the carpal tunnel in fresh cadavers, and to assess if tensioning and sliding techniques induce the same effect on fluid dispersion. Design: A biomimetic solution was injected under the epineurium of the median nerve at the level of the transverse carpal ligament. The initial dye spread was allowed to stabilize and measured with a digital caliper. Setting: Cadaver laboratory. Participants: Fourteen upper extremities of seven cadavers were used. Interventions: Once the initial longitudinal dye spread stabilized, a randomized crossover design was applied. Tensioning and sliding techniques were applied randomly and sequentially to each upper extremity and performed for a total of five minutes each.
Abstracts / PM R 9 (2017) S131-S290
Participants: Two normal controls. Interventions: No applicable. Main Outcome Measures: Creation of video and picture of the alternative view. Results: In a forearm held in the resting UMN injury pattern, the FDP is close to the top of the image just volar to the ulna, the FDS is deep to the FCU, and FDS and FCU are both lateral to FDP. Conclusions: A new teaching resource was developed to demonstrate the relative forearm muscle position in a more clinically relevant context for teaching US-guided forearm muscle injections. Level of Evidence: Level V Poster 83: Is It Possible to Diagnose Borderline Mild Carpal Tunnel Syndrome in Nerve Conduction Studies with Normal Median Motor and Sensory Latencies Without Using the Combined Sensory Index? Marc A. Raj, DO (LSU Health Med Cntr), Stephen Kishner, MD, Elena Khoutorova, Medical Student 4, Casey A. Murphy, MD Disclosures: Marc Raj: I Have No Relevant Financial Relationships To Disclose Objective: To determine criteria which can accurately predict or rule out borderline carpal tunnel syndrome in symptomatic patients with normal Median nerve sensory and motor latencies without the need to perform combined sensory indices using only Median to Ulnar motor and sensory latency differences. Design: Retrospective chart review. Setting: Outpatient PM&R clinic. Participants: 499 nerve conduction studies in 300 patients over a period of 9 years. Interventions: Not Applicable. Main Outcome Measures: Both Median to Ulnar nerve sensory and Median to Ulnar motor latency differences were calculated. Sensory, motor, and combined sensory/motor latency differences were correlated to the results of combined sensory index for their respective study using regression analysis. The regression analysis was then used to determine which latency differences would provide accurate predictions of the combined sensory index. Results: A combined Median to Ulnar nerve motor and sensory latency difference greater than 1.4ms (n¼113) had a specificity of 94% with a positive predictive value of 87% in predicting positive combined sensory indices. A combined Median to Ulnar nerve motor and sensory latency difference less than 0.5ms (n¼107) had a sensitivity of 90% with a negative predictive value of 75% in predicting negative combined sensory indices. These criteria were present in n¼220 (approximately 44% of studies). Conclusions: A combined Median to Ulnar nerve motor and sensory latency difference greater than 1.4ms can accurately predict borderline mild carpal tunnel syndrome without the need for combined sensory indices. Caution should be used in ruling out borderline mild carpal tunnel syndrome based on a combined Median to Ulnar nerve motor and sensory latency difference of less than 0.5ms as there is a relatively high false positive value of 25%. Level of Evidence: Level II Poster 86: Disorders of Consciousness due to Anoxic Brain Injury: A Case Series of 8 Patients Mark A. Linsenmeyer, MD (University of Pittsburgh Medical Center), Shanti M. Pinto, MD, Gary N. Galang, MD Disclosures: Mark Linsenmeyer: I Have No Relevant Financial Relationships To Disclose Objective: To characterize common medical complications, treatments, and recovery in patients with disorders of consciousness (DOC) due to anoxic brain injury (ABI).
Design: Retrospective case series. Setting: Academic inpatient rehabilitation (IPR) center. Participants: Eight patients with current or recent DOC due to ABI without history of head trauma who were admitted to IPR from 20152016. Interventions: Not applicable. Main Outcome Measures: Primary outcome measures included change in function (as measured by FIM score) and level of consciousness (as measured by JFK/CRS-R score). Secondary outcome measures included medical comorbidities (paroxysmal sympathetic hyperactivity [PSH], spasticity, movement disorders, seizures, or infections) and discharge destination. Results: On admission to IPR, 5 patients were vegetative and 3 had recently emerged from minimally conscious state (MCS). During IPR course, 2 vegetative patients emerged, 1 became minimally conscious, and 2 remained vegetative. FIM scores on admission were 18 or below for all patients and improved in 4 patients by an average of 40 points. Scores did not improve for the remaining 4. All patients were given neuropharmacologic medications for arousal and attention. PSH affected 6/8 patients and clinically resolved for 2 patients prior to discharge. 6/8 patients had spasticity, resolving in 3 by discharge. 5/8 patients exhibited movement disorders, primarily myoclonus. 7/8 patient developed urinary tract infections. No patients developed seizures during IPR admission, but 2/8 patients experienced status epilepticus prior to IPR. Overall, 6/8 patients were discharged to home. Conclusions: In IPR, patients with DOC due to ABI presented with prominent neurological and cognitive deficits, for which they were prescribed neuropharmacologic agents in conjunction with therapies. Common limitations to rehabilitation include the severity of deficits in arousal and cognition, PSH, spasticity, movement disorders, and a high rate of infection; however, many patients were frequently discharged to the home setting. Further investigation into predictors of outcome and optimal medical management for this population is warranted. Level of Evidence: Level IV
Poster 87: Effect of Neurodynamic Mobilizations on Fluid Dispersion on Median Nerve at the Level of the Carpal Tunnel: A Cadaveric Study Mathieu Boudier-Reveret (Universite´ du Que´bec a` Trois-Rivie`res, Trois-Rivie`res, Que´bec, Canada), Ste´phane Sobzack, PT, MSc, PhD, Kerry K. Gilbert, PT, ScD, Jean-Michel Brismee, PT, ScD, Pierre-Michel PM. Dugailly, PhD, Ve´ronique Freipel, PhD, Mehdi Moussadyk, Msc, Dorra Rakia DR. Allegue, pht, MSc Disclosures: Mathieu Boudier-Reveret: I Have No Relevant Financial Relationships To Disclose Objective: To evaluate the effect of neurodynamic mobilizations on an artificially induced intraneural edema in the median nerve at the level of the carpal tunnel in fresh cadavers, and to assess if tensioning and sliding techniques induce the same effect on fluid dispersion. Design: A biomimetic solution was injected under the epineurium of the median nerve at the level of the transverse carpal ligament. The initial dye spread was allowed to stabilize and measured with a digital caliper. Setting: Cadaver laboratory. Participants: Fourteen upper extremities of seven cadavers were used. Interventions: Once the initial longitudinal dye spread stabilized, a randomized crossover design was applied. Tensioning and sliding techniques were applied randomly and sequentially to each upper extremity and performed for a total of five minutes each.